Little is known about risk factors for emergency department (ED) attendance for chronic pain (CP) management and the relative service burden. We examined emergency department (ED) utilisation in patients with chronic pain (CP), identified risk factors associated with attendance for chronic musculoskeletal pain (CMP) and estimated the comparative cost of treatment. The study cohort comprised a random sample of 3,700 adults from the general population in Tayside, Scotland. Linked regional extracts, spanning a 12-month period, were obtained from national registers, providing information on ED attendances, community-dispensed prescribing and outpatient clinic attendances. The NHS Scotland Cost Book was used to ascertain the current average cost of an ED attendance (£130; ∼$167).All-cause ED attendance was higher in those with CP (68.5%; n=252) than without (29.3%; n=967). In the entire cohort, more patients attended the ED for the treatment of CMP than for any other medical condition (n=119; 32.3% of those with CP). Risk factors for ED attendance for CMP were: recent analgesic dose decreases (OR=4.55); and transitioning from opioid to non-opioid analgesics (OR=5.08). Characteristics protective of ED attendance for CMP were: being in receipt of strong opioids (OR=0.21); transitioning from non-opioid to opioid analgesics (OR=0.25); recent analgesic dose increases (OR=0.24); and being prescribed tricyclic antidepressants (OR=0.10), benzodiazepines (OR=0.46) or hypnotics (OR=0.45). CMP was one of the most expensive conditions to treat (£17,680 (∼$22,668) per annum), conferring a substantial burden on ED services. Improved understanding of the risk/protective factors could inform healthcare redesign to reduce avoidable ED attendances for CMP management.